Autopsy of a 55-year-old man who died of heart failure reveals dilation of the proximal aorta with linear wrinkled intimal scars described as tree-bark deformity, and aortic valve insufficiency. Which microscopic feature supports the underlying cause?
- A Fibrinoid necrosis of the vasa vasorum with neutrophilic infiltrate
- B Cystic medial degeneration with mucopolysaccharide deposition
- C Obliterative endarteritis of the vasa vasorum with plasma cell-rich infiltrate ✓
- D Giant cell granulomatous inflammation of the media
Correct answer: C. Obliterative endarteritis of the vasa vasorum with plasma cell-rich infiltrate
Explanation
Syphilitic aortitis involves the ascending aorta, where obliterative endarteritis of the vasa vasorum with plasma cells leads to medial necrosis, aneurysm, aortic regurgitation, and tree-bark intima. Giant cell aortitis is a distinct entity, cystic medial degeneration characterizes Marfan syndrome, and fibrinoid necrosis suggests vasculitis rather than syphilis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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